Purpose
The purpose of this study was to investigate and validate the accuracy and safety
of a technique using an anterior approach for non–image-guided intra-articular injection
of the hip by use of anatomic landmarks.
Methods
We enrolled 55 patients. Injections were performed before supine hip arthroscopy after
landmarking and before application of traction. After the needle insertion, success
was confirmed with an air arthrogram and by direct visualization after arthroscope
insertion. Accuracy and difficulty achieving correct needle placement were correlated
with age, weight, height, body mass index, body type, gender, and surgical indication,
as well as femoral and pelvic morphology. Forty-five patients who underwent injection
in the office were followed up separately to document injection side effects. Needle
placement accuracy was correlated to patients' demographics. All statistical tests
with P values were 2 sided, with the level of significance set at P < .05.
Results
There were 51 correct needle placements and 4 misses, yielding a 93% success rate.
The most common location for needle placement was the upper medial head-neck junction.
Female gender was correlated with a more difficult needle placement and misses in
relation to group size (P = .06). The reasons for misplacements of the needle were a high-riding trochanter,
increased femoral version, thick adipose tissue over the landmarks, and variant of
ilium morphology. Of 45 patients in the side effect study arm, 3 reported sensory
changes of the lateral femoral cutaneous nerve that resolved within 24 hours.
Conclusions
Hip injections by use of the direct anterior approach, from the intersection of the
lines drawn from the anterior superior iliac spine and 1 cm distal to the tip of the
greater trochanter, are safe and reproducible. Patient characteristics, such as increased
subcutaneous adipose tissue or osseous anatomic variants, can lead to difficulty in
placing the needle successfully. These characteristics can be predicted with the aid
of physical examination and careful study of the pelvic radiographs.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: April 15, 2013
Accepted:
February 12,
2013
Received:
August 20,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
